Larynx In Patients Research Articles

Clinical manifestations of autoimmune rheumatic diseases in the larynx

Introduction. Autoimmune rheumatic diseases are attributed to a systemic process that develops in many organs, including the larynx. Complaints of impaired vocal function in patients with this pathology require a thorough clinical and endoscopic analysis.The purpose of the study. To determine the clinical-endoscopic changes of the larynx in patients with impaired vocal function in autoimmune rheumatic diseases..Materials and methods. 31 (100%) patients aged 25 to 84 (41 ± 15) years with autoimmune rheumatic diseases applied to the phoniatric department of the St. Petersburg Research Institute of ENT. There were 3 men (10%), 28 women (90%). All patients complained of impaired vocal function, 5 of the examined (16%) were also concerned about breathing disorders during exercise or at rest.Patients were grouped into three groups: systemic lupus erythematosus 4 (13%) people, systemic vasculitis 10 (32%) people, rheumatoid arthritis 17 (55%) people.Videolaryngoscopy, videolaryngostroboscopy, autofluorescence endoscopy, NBI – endoscopy (according to indications) were used to make the diagnosis.Results. The distribution of laryngeal pathology by nosological forms in patients with аutoimmune rheumatic diseases was as follows. The most numerous were groups with functional dysphonia of the hypotonic type 10 (32%) and bamboo nodules of 8 (26%) patients. Chronic laryngeal stenosis was diagnosed in 5 (16%), and chronic catarrhal laryngitis and soft nodules of the vocal folds in 3 (9.5%) people in each group (respectively). The smallest number of patients suffered from ulcerative necrotic changes of the larynx and pharynx – 2 (7%).Conclusion. Thus, laryngeal changes in аutoimmune rheumatic diseases had both specific manifestations and non-specific ones. The latter include functional dysphonia of the hypotonic type, chronic catarrhal laryngitis, soft nodules of the vocal folds. Bamboo nodules of the vocal folds, ulcerative necrotic diseases, chronic laryngeal stenosis (infiltrative and scarring) were specific for patients with аutoimmune rheumatic diseases.

Neuromuscular electrophonopedic stimulation of the larynx after surgical treatment of patients with differentiated thyroid cancer

BACKGROUND: Thyroid cancer is the most common endocrine malignancy, accounting for 3.4% of all cancers diagnosed annually. Differentiated thyroid cancer (DTC) is primarily treated with surgery, which can often involve complications such as postoperative pareses or reversible laryngeal nerve (RLN) paralysis. Currently, rehabilitation possibilities for patients with postoperative RLN pairs are relevant. In this study, we used neuromuscular electrostimulation with vocaSTIM in combination with drug therapy and evaluated the effectiveness of the rehabilitation. AIMS: To determine the possibility of using neuromuscular electrophonopathic laryngeal stimulation (NMELS) in restoring laryngeal function after surgical treatment of DTC complicated by pareses/paralysis of thr RLN. MATERIALS AND METHODS: Seventy-six patients with DTC who have undergone surgical treatment, complicated by paresis of RLN, were enrolled in this study. RESULTS: The study analyzed the treatment results of these 76 patients. The age of the patients ranged from 6 to 78 (average age, 47) years, the female-to-male ratio was 59 to 17 (women, 77.6%; men, 22.4%). Postoperative unilateral laryngeal paresis was present in 56 patients (73.68%) and bilateral lesions in 20 (26.32%). Phonation violation was found in all patients: dysphonia, 76 (100%); dysphagia, 28 (36.84%); and respiratory failure, 11 (14.47%), and 2 patients (2.63%) were tracheotomized postoperatively. All patients underwent neuro-phonic rehabilitation with mandatory assessment and video fixation of laryngeal function. As a result of neuromuscular electrophonopathic stimulation of the larynx, 69 out of 76 patients (90.79%) had improved larynx function. CONCLUSIONS: Based on our experience, NMELS with vocaSTIM can be used for restoring the functions of the larynx in patients with RLN paresis of varying severities, after surgical treatment for DTC.

Infectious and noninfectious epiglottitis in adults: our experience

Background: The present prospective study was conducted in the department of ENT at GMC Doda for a period of three years from February 2019 to March 2022. The study aimed at evaluating the causes, presentation and management of adult epiglottitis. Methods: The patients presenting with the sign and symptoms of epiglottitis were evaluated and were subjected to rigid/flexible endoscopic examination. Patients presenting with respiratory distress were categorized as per Freidman’s classification. Results: Epiglottitis was seen in 21 patients with 13 male and 8 female patients. The age distribution was between 26 and 68 years (mean, 44.4±11.3). Infection, as a cause of epiglottitis was present in 14 subjects and 7 patients had non infectiousetiology. Corrosive ingestion (HCL) and angioedema was seen in two patients each. Hot water aspiration, hot milk and foreign body aspiration (fish bone) was present in the rest of three patients each. Most common complaint of patients in our study was sore throat followed by painful swallowing and voice change. Conclusions: Epiglottitis in adults can be easily overlooked because of its non-specific presentation. Importance needs to be stressed upon the examination of larynx in patients presenting with sore throat not responding to conventional treatment or with symptoms of respiratory distress and voice change. Airway management should be take preference in patients having stridor before embarking on laryngeal examination with close Follow up.

Комплексное лечение хронической патологии гортани при болезни Шегрена

Issues of voice quality and health, as the main means of communication, are becoming increasingly relevant. One of the causes of dysphonia is Sjögren’s disease. Progressive dryness of the mucous membrane of the upper respiratory tract, autoimmune disorders lead to the development of chronic pathology of the vocal apparatus. Treatment methods traditionally used for chronic pathology of the larynx do not achieve high and lasting improvement in voice quality in patients with Sjögren’s disease. The purpose of this study was to evaluate the effectiveness of the developed method of complex treatment of chronic laryngeal pathology in Sjögren’s disease. 46 patients with voice disorders associated with Sjögren’s disease were examined and treated. The patients were divided into two groups. Group I (20 patients) received treatment traditionally used for chronic laryngitis. In group II (26 patients), complex treatment was supplemented by three-stage aerosol therapy of the mucous membrane of the upper respiratory tract with saline solution sounded by low-intensity ultrasound, intranasal application of a drug containing hyaluronic acid, and light therapy to the larynx area. Based on an assessment of the dynamics of patient complaints, data from videolaryngostroboscopy, acoustic analysis of the voice, and the results of a questionnaire using a visual analogue scale for the severity of dryness of the mucous membrane of the upper respiratory tract, a comparative analysis of the results of therapy demonstrated a more striking and lasting improvement in the clinical and functional state of the larynx in patients of group II. Thus, the developed method of complex treatment of chronic pathology of the larynx in Sjögren’s disease, including three-stage aerosol therapy of the mucous membrane of the upper respiratory tract with saline solution sounded by low-intensity ultrasound, light therapy to the larynx area, and a topical preparation containing hyaluronic acid, allows achieving a pronounced positive effect with an aftereffect for 5 months.

Functional and oncological results of endolaryngeal laser resections of squamous-cell carcinomas of the voice box

Introduction. Treatment with the initial stage of the disease causes a high need for the use of organ-preserving treatment methods, which are actively developing and improving. One of the modern and promising methods is endolaryngeal resection of the larynx.Aim. To evaluate oncological effectiveness and functional results of endolaryngeal laser resections in cancers of the voice box.Materials and methods. The study included 139 patients with squamous-cell carcinoma of the voice box between the ages of 26 and 81 years who received treatment at the Department of Head and Neck Oncology of the federal medicalBiological Agency of the Russian federation between 2015 and 2020. All patients underwent standard examination to diagnose oncological diseases and were diagnosed in accordance with the Tumor, Node and metastasis (TNm) international system. In 90 (64.7 %) of 139 patients, squamous-cell laryngeal cancer T1N0m0 was diagnosed, in 49 (35.3 %) patients – T2N0m0. All patients underwent surgical treatment in the form of endolaryngeal laser resection according to the plan developed during an oncological council.Results. After endolaryngeal laser resections, 3-year recurrence-free survival for cancer of the voice box, stages т1 and т2, was 92 and 84.2 % respectively. Temporary disruption of separating function of the larynx in patients with stage T2N0m0 was observed in 6.1 % cases, decreased vocal function in 100 % of cases, granuloma formation in the postoperative period in 19.4 % of cases, formation of a scar narrowing the laryngeal lumen in 4.3 % of cases.Conclusion. High 3-year recurrence-free survival as well as small percentage of postoperative complications and severe functional abnormalities show high effectiveness of endolaryngeal laser resections in treatment of cancer of the voice box and recommend this technique for active use in daily practice of head and neck tumor specialists.

Larynx-preserving hybrid surgery with endoscopic laryngopharyngeal surgery and open surgery for cervical esophageal cancer invading pharynx.

Larynx preserving hybrid surgery with endoscopic laryngopharyngeal surgery and open surgery (HELPS) was created for resectable cervical esophageal cancer (CEC) invading the hypopharynx. This study aimed to verify the effectiveness and to evaluate the feasibility of the new HELPS treatment method. Between 2014 and 2018, 19 patients with CEC invading the hypopharynx were treated with HELPS. The postoperative complications and survival rates were reviewed. Postoperative recurrent laryngeal nerve paralysis occurred in four patients. All patients consumed food orally without a feeding tube at the time of the discharge. The median follow-up period was 27months. The 2- and 3-year overall survival rates were 94.7 and 71.5%, respectively. HELPS, a new surgical treatment method that utilizes endoscopic surgery, is effective, feasible and beneficial for preserving the larynx in patients with CEC even if the tumor invaded the pharynx.

H+/K+ATPase Expression in the Larynx of Laryngopharyngeal Reflux and Laryngeal Cancer Patients.

The gastric H+/K+ ATPase proton pump has previously been shown to be expressed in the human larynx, however its contribution to laryngopharyngeal reflux (LPR) signs, symptoms and associated diseases such as laryngeal cancer is unknown. Proton pump expression in the larynx of patients with LPR and laryngeal cancer was investigated herein. A human hypopharyngeal cell line expressing the proton pump was generated to investigate its effects. In-vitro translational. Laryngeal biopsies were obtained from three LPR and eight LSCC patients. ATP4A, ATP4B and HRPT1 were assayed via qPCR. Human hypopharyngeal FaDu cell lines stably expressing proton pump were created using lentiviral transduction and examined via transmission electron microscopy and qPCR for genes associated with inflammation or laryngeal cancer. Expression of ATP4A and ATP4B was detected in 3/3 LPR, 4/8 LSCC-tumor and 3/8 LSCC-adjacent specimens. Expression of ATP4A and ATP4B in FaDu elicited mitochondrial damage and expression of IL1B, PTGS2, and TNFA (P < .0001); expression of ATP4B alone did not. Gastric proton pump subunits are expressed in the larynx of LPR and LSCC patients. Mitochondrial damage and changes in gene expression observed in cells expressing the full proton pump, absent in those expressing a single subunit, suggest that acid secretion by functional proton pumps expressed in upper airway mucosa may elicit local cell and molecular changes associated with inflammation and cancer. NA Laryngoscope, 131:130-135, 2021.

Prognostic factors for survival and nonfunctional larynx in patients with squamous cell carcinoma of the larynx.

Prognostic variables upon presentation can assist in recommending the optimal treatment for patients and may help in management of patient's expectations and side effects. Our objective was to evaluate prognostic factors for survival and nonfunctional larynx in patients with laryngeal squamous cell carcinoma (SCC). Retrospective chart review. All patients diagnosed as having laryngeal SCC from January 2007 through December 2016 in a tertiary, university-affiliated medical center were reviewed. Main outcomes were survival and nonfunctional larynx rate. Two hundred sixty-five patients were identified; the male:female ratio was 4.5:1. Mean age at diagnosis was 64 ± 11.8 years. Overall and disease-free survival were 7.9 and 6.7 years, respectively. A univariate analysis found that older age significantly affected survival. Alcohol abuse, diabetes mellitus, and advanced disease stage at presentation were also found to decrease survival but were not significant. A multivariate Cox regression found age, alcohol abuse, and advanced disease stage to significantly affect and lower survival (P < .05). Of the entire cohort 19% were defined as having a nonfunctional larynx (e.g., tracheostomy or feeding-tube dependent). A backward logistic regression found that male sex and advanced disease stage increased the risk, and anterior commissure involvement was found to lower the probability of nonfunctional larynx (P < .01). Older age, history of alcohol use, and advanced disease stage at presentation negatively affect survival in larynx cancer patients. Male gender and advanced disease stage increased the risk, and anterior commissure involvement was found to lower the risk for tracheostomy or feeding-tube dependency. 4 Laryngoscope, 130:1202-1205, 2020.

Importance of timely diagnosis of diseases of the larynx during initial examination performed by an otorhinolaryngologist

Diagnosis and treatment of diseases of the larynx in patients with dysphonia are an urgent task of modern otorhinolaryngology. The reason for this is the constant growth of professions with high requirements for voice quality. The modern methods of diagnosis in diseases of the larynx are based on endoscopic diagnostic techniques. The article provides detailed description of the clinical and endoscopic signs of functional and organic diseases of the larynx that are significantly more prevalent in voice professionals: hypotonic and hypo-hypertonic functional dysphonia, soft and hard vocal fold nodules, acute and chronic occupational laryngitis, and vascular pathology of vocal cords. The article presents the main approaches to the treatment of diseases of the larynx, including using the drug Homeovox. The article will be useful to the otorhinolaryngologists of the outpatient network to establish the diagnosis and assign а therapy to the voice and speech professionals.

A meta-analysis of prenatal diagnosis of congenital malformations of the airways

Congenital malformations of the respiratory tract is an important issue. They cause more than 100 deaths annually in the Russian Federation. The definition and classification of congenital malformations of the respiratory tract are described and developed by Je. A. Cvetkov. The ultrasound is the primal method used in prenatal diagnosis of congenital malformations of the upper respiratory tract. Starting from the age of 17-23 weeks old, the ultrasound shows the following signs: hyperechoic lungs, dilatation of the lower respiratory tract, flattening of the diaphragm. This ultrasound pattern is typical for Congenital High Airway Obstruction Syndrome (CHAOS). If the doctor suspects an identifying of these signs, a follow-up examination is recommended. If the congenital obstruction of the upper respiratory tract is diagnosed during the pregnancy, the childbirth for patients must be performed in the hospital, where it is possible to perform tracheotomy and artificial ventilation of the lungs to the newborn, to operate him with placental support. This type of surgical treatment by the EXIT method (The ex utero intrapartum treatment procedure) is a new stage in neonatal surgery. A meta-analysis of 15 articles in the foreign literature about the detection of CHAOS from 1993 to 2014 was conducted. The analysis includes studies with more than 5 described cases. The statistics of diagnosis and treatment of congenital malformations of the larynx of patients of the ENT clinic of SPbSPMU for the period from 2003 to 2016 with the diagnosis of congenital malformation of the larynx is presented.

F95. Laryngeal electromyography in patients with Amiotrophic Lateral Sclerosis (ALS): Preliminary results

Introduction Amyotrophic Lateral Sclerosis (ALS) is the most relevant motor neuron disease in adults and characterized by widespread weakness. Despite frequent bulbar involvement, little is known about clinical and electrophysiological changes in the larynx in patients with ALS. The objective of this study was to evaluate the frequency and pattern of involvement of laryngeal muscles in ALS and its functional relevance. In addition, we assessed whether laryngeal EMG (LEMG) would increase the diagnostic sensitivity for ALS. Methods Fourteen ALS patients, 13 with spinal onset and 1 with bulbar onset, underwent nasofibroscopy (NF) followed by LEMG, in which a concentric needle was used to evaluate the thyroid-arytenoid (TA), lateral crico-arytenoid (CAL), posterior crico-arytenoid (CAP) and crico-thyroid (CT) muscles, at rest and during activation. After LEMG, resting and activation of the genioglossus and masseter muscles were also studied using the same concentric needle. Results The mean age of the patients was 48.5 years and there were 6 women. The procedures were fast (30 min on average) and uneventful. Thirteen patients presented neurogenic changes in at least one laryngeal muscle. A single patient had entirely normal LEMG. We found a pattern compatible with chronic denervation (MUAPs remodeling and incomplete recruitment) with the following frequency: TA muscle in 11/14 patients (78.5%); CT in 10/14 patients (71.4%); CAP in 10/14 patients (71.4%) and CAL in 7/14 patients (50%). In 8 patients, there were fibrillations and/ or fasciculations associated with chronic neurogenic changes in the same muscle; of these, 4 had no alteration in the genioglossus muscle and 2 had only chronic alterations in the same muscle. NF revealed motor abnormalities in the larynx in 9 patients; in the remaining 5, NF was normal but LEMG identified signs of denervation in 4 of them. Conclusion LEMG is able to identify laryngeal denervation in patients with ALS. This procedure may increase diagnostic sensitivity for ALS by identifying bulbar involvement in patients without tongue denervation. Changes in LEMG may precede clinical involvement of the larynx in these patients.

Hypoparathyroidism in Total Thyroidectomy due to Benign Thyroid Diseases

PurposeOur aim was to compare the effects of exposing the recurrent laryngeal nerve throughout its entire course with exposing the nerve only at its entry to the larynx in patients undergoing total thyroidectomy due to benign thyroid diseases, and to evaluate the effects of these methods on the risk for hypoparathyroidism. MethodsThe medical records of 437 patients who had undergone total thyroidectomy at the ear, nose, and throat clinic between 2001 and 2015 for benign thyroid diseases were evaluated retrospectively. Mean patient age was 46.7 years (range 18–79 years). Eighty-six patients were male and 351 were female. Patients were divided into 2 groups according to recurrent laryngeal nerve exposure during surgery. In the first group, the nerve was observed as it entered the larynx, and its course was not completely exposed. In the second group, the nerve was identified in the tracheoesophageal groove, and its course was fully exposed. Group 1 consisted of 256 patients (47 male and 209 female) and group 2 consisted of 181 patients (39 male and 142 female). There were no statistically significant differences between the groups in terms of age and gender, and the groups were homogeneously distributed. FindingsTransient hypoparathyroidism was observed in 15 (5.8%) patients and permanent hypoparathyroidism was observed in 3 (1.1%) patients in group 1, and transient hypoparathyroidism was observed in 23 (12.7%) patients and permanent hypoparathyroidism was observed in 7 (3.8%) patients in group 2. The rates of both transient and permanent hypoparathyroidism were higher in the patients in group 2, and the difference was statistically significant (P < 0.001). Transient recurrent nerve palsy was seen in 1 patient in each group. Permanent recurrent nerve palsy occurred in 1 patient in group 2, although the difference between groups was not statistically significant (P = 0.28). ImplicationsTransient and permanent hypoparathyroidism were less common in thyroidectomies that involved detection of the recurrent laryngeal nerve at the site of entry to the larynx and keeping its dissection minimal; this technique was also more reliable.

Computational fluid dynamics in the assessment of patients' postoperative status after glottis-widening surgery.

Computational fluid dynamics (CFD), a rapidly developing instrument with a number of practical applications, allows calculation and visualization of the changing parameters of airflow in the upper respiratory tract. The aim of this study was to demonstrate the advantages of CFD as an instrument for noninvasive tests of the larynx in patients who had undergone surgical treatment due to bilateral vocal fold paralysis. Surface measurements of the glottic space were made during maximum adduction of the vocal folds. Additionally, the following spirometric parameters were determined: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and peak expiratory flow (PEF) rate. Based on the measurements, commercial mesh generation software was used to develop a geometrical model of the glottic space. The computations were carried out using a general purpose CFD code. The analysis included patients who were surgically treated for BVFP in the authors' department between 1999 and 2012. The study group consisted of 22 women (91.67%) and 2 men (8.33%). It was observed that the pressure drop calculated for free breathing depends on the area of the glottis and is independent of its shape. Importantly, for areas below approx. 40 mm2, a sudden rise occurred in the resistance to flow; for the smallest glottic areas studied, the pressure drop was almost 6 times higher than for an area of 40 mm2. Consequently, in cases of areas below 40 mm2 even minor enlargement of the glottic opening can lead to a marked improvement in breathing comfort. Computational fluid dynamics is a useful method for calculating and visualizing the changing parameters of airflow in the upper respiratory tract.

Analysis of degree of incidence of small anatomic anomalies of larynx among dysphonia patients

The disturbance of the voice function is a socially significant problem. Small anatomical anomalies (SAA) along with organic causes of impaired voice function can cause dysphonia. Disturbances of the voice in the presence of SAA belong to little studied and persistent dysphonias. Information about the prevalence of this group of anomalies in domestic and foreign literature is few and controversial. Objective: to determine the incidence of SAA of the larynx in patients with dysphonia. Materials and methods: Retrospectively were analyzed the 58 case histories of patients who were diagnosed with functional dysphonia in the clinic of diseases of ear, nose and throat of Sechenov First MSMU from 01.09.2011 to 01.10.2015. Patients underwtent video￾stroboscopic and fibrolaryngoscopy studies. Results: Average age 37 ± 6 years, women-37 (64%), men – 21 (36%). In 27 (47%) patients spastic dysphonia was diagnosed, 23 (39%) – dysphonia hipotenusa, 7 (12%) – mutational dysphonia, only 1 (2%) patient in the course of stroboscopic studies was diagnosed with SAA - grooves of both vocal folds. Conclusions: the SAA of the larynx are small and the prevalence with early detection and treatment can produce favorable prognosis. However, being a disease with unknown etiology and prevalence until the end and if untreated can lead to adverse consequences and should not remain undiagnosed. It should be kept in mind during differential search to find out the cause of dysphonia.

Treatment algorithm of postoperative management of patients with chronic edematic polypous laryngitis

The authors conducted complex examination of 200 patients with chronic edematic polypous laryngitis and determined the specific aspects of clinical and functional condition of larynx of patients before and after the surgery and described the course of postoperative laryngitis. The article proves that the functional pathology of larynx revealed in 66% of post-surgery patients increases the duration of post-surgery dysphonia. It is proven that application of neuromuscular electrophonopedic stimulation of larynx facilitates normalization of larynx physiology by the 14th day after the operation, reducing sonorous voice recovery period in average by 7–14 days. Application of the proposed method made it possible to achieve significant increase in the efficiency of post­operative treatment of patients with chronic edematic polypous laryngitis.

A Study on Diagnostic Importance of Fiber Optic Laryngoscopy (FOL) in Patients with Upper Airway Disorders

Background: Upper airway symptoms are quite common. Many of these symptoms underlie serious upper airway pathologies which should be diagnosed at an early stage so that optimum treatment can be given. Often it seems to be difficult to diagnose upper air way pathology by conventional indirect laryngoscopy (I/L), especially when the lesion is at an early stage. In this situation fiber optic laryngoscopy (FOL) is very helpful.Objective: To identify lesions in the larynx in patients with persistent upper airway disorders and to compare the diagnostic yield of FOL over I/L.Method: This was a cross-sectional study conducted partly in department of ENT and Head &amp; neck surgery, BIRDEM General Hospital and partly at the same department of BSMMU during the period of July to December 2012. 100 adult patients were taken having upper airway symptoms. Study subjects were evaluated by history, physical examinations, and ENT examinations. All patients underwent indirect laryngoscopy and FOL. Data were recorded and analyzed.Results: Age of the respondents was between 18-72 years. The mean ± SD was 54 ±11.79 years. Common symptoms among the participants were hoarseness, sore throat, neck swelling, breathless ness, cough, odynophagia, earache etc. On I/L examinations 30% were vocal cord polyps, 14% v. cord edema, 17% v. cord growths, 11% v. cord nodules, 6 % v. cord palsy, 4% ulcerated lesions, 13 % poor vision and 5% were normal. On FOL examinations, 30% were vocal cord polyp, 18% v. cord edema, 21% v. cord growth, 14% v. cord nodule, 8 % v. cord palsy, 5% ulcerated lesion, 2% laryngeal web, 2 % were normal study and there were no poor vision. A comparison was made between the findings of I/L and FOL which showed that FOL is superior to I/L in diagnosing upper airway disorders as evidenced by findings of 2% lesions among 5% patients having normal I/L findings. Chi-square test was done between I/L and FOL findings which was statistically significant; (P value was .002) i.e. FOL procedure is valuable diagnostically in comparison to I/L.Conclusion: In many occasions I/L findings are inconclusive in daily ENT practice. Moreover, in some cases there is poor vision to identify the lesion. Therefore, Routine FOL evaluation is valuable in patients with significant, chronic and progressive upper airway symptoms. It should always be considered in patients with persisting and progressive symptoms even though I/L appeared normal.J Bangladesh Coll Phys Surg 2014; 32: 200-205

Is laryngeal involvement in pemphigus vulgaris rare? A review

&lt;p&gt;The lesions of pemphigus in the larynx have been reported as case reports. However, the frequency with which it occurs is not known. The purpose of this study was to investigate the incidence of laryngeal involvement in pemphigus vulgaris and to examine the laryngeal lesions and the treatment in detail. The databases searched were PubMed, EMBASE, Cochrane Library and Google scholar. The involvement of larynx in patients with pemphigus vulgaris is common. The most common parts involved are epiglottis and arytenoids. This study indicates that laryngeal symptoms are common in pemphigus vulgaris. Laryngeal findings must be considered at the beginning of diagnosis for the better management and to prevent life threatening complications.&lt;/p&gt;

Surgical Outcomes of Primary versus Flap Closure of Postradiation Laryngectomy Defect

Objectives: The authors of the RTOG 91-11 study recently presented long-term outcomes for 3 nonsurgical treatment strategies to preserve the larynx in patients with locally advanced laryngeal cancer. They concluded that concomitant chemotherapy and radiation is optimal for laryngeal preservation; however, 16% of the patients still required total laryngectomies (TL). Additionally, the incidence of pharyngocutaneous fistulas was 30% within this cohort receiving total laryngectomy. We therefore conducted a single center retrospective study of 47 patients treated with total laryngectomy at a tertiary care center from July 2004 to May 2013 to assess the percentage of patients that develop pharyngocutaneous fistula. We propose that the rate of pharyngocutaneous fistula in patients that receive TL will be lower using the technique of flap augmentation compared with the patients that receive TL using the technique of primary closure. Methods: Thirty-two patients received primary closure for TL with a pharyngocutaneous rate of 9.4% (n = 3), and 14 patients received flap augmentation for TL with a pharyngocutaneous rate of 7.1% (n = 1). We also assessed stage of laryngeal cancer; whether the patient received cheomotherapy, radiation therapy, or concomitant radiation and chemotherapy; the muscle used for flap closure; recipient artery and vein; thyroid-stimulating hormone, hemoglobin, intact parathyroid hormone, and albumin preoperative and postoperative values, when available. Results/Conclusions: The rate of pharyngocutaneous fistula was comparable between the primary closure group and the flap closure group ( P = 1). However, because of the low rate of pharyngocutaneous fistulas, it would be necessary to analyze a larger cohort to determine significance and possible confounding factors.

Spiral computed tomography of the neck with different options of scanning techniques in the diagnostics of neuropathic stenosis of the larynx in patients with thyroid cancer

Spiral computed tomography of the neck with different options of scanning techniques in the diagnostics of neuropathic stenosis of the larynx in patients with thyroid cancer

Efficacy of radical radiotherapy alone for functional preservation of larynx in laryngeal carcinoma: a retrospective analysis.

Concurrent chemoradiation is the current standard of care in locally advanced head and neck cancer. But, in our setup, many patients of carcinoma larynx are treated with only radical radiotherapy because of poor general condition of the patients. This study was performed to assess the influence radical radiotherapy alone on functional preservation of larynx. 110 previously untreated patients with invasive squamous cell carcinoma of larynx were treated with radical radiotherapy alone between January 2006 and June 2009. Conventional one daily fraction of 2 Gy with total doses of 60-66 Gy was used. Voice preservation and local control at median follow-up period of 2 years were analyzed. Several host, tumor, and treatment parameters were also analyzed. Among 110 patients, preservation of larynx was possible in 78 patients (71%). With radical radiotherapy alone, excellent preservation of larynx was achieved in stage I (88.9%) and stage II (75%) disease, while in advanced stages, results were not so encouraging. In stage III and stage IVA, larynx preservation was only 72.4% and 65.3%, respectively. Patients without any cartilage invasion had significantly better laryngeal preservation rate as compared to patients with cartilage invasion. (78.9% vs. 35.3%; P = 0.008). Though concurrent chemoradiation is the standard of care in preservation of voice in laryngeal cancer, definitive radiotherapy alone may also be a good option in terms of preservation of larynx in patients of laryngeal cancer in community practice in the developing world where most of the patients cannot tolerate concurrent chemoradiation.